Diagnostic yield of cerebral imaging in patients with acute confusion

Hufschmidt, Andreas; Shabarin, V.

doi:10.1111/j.1600-0404.2008.01006.x

Cited by 44 publications

(50 citation statements)

References 21 publications

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“…Due to difficulty in assessing the preadmission cognition level, imaging is often used to rule out acute pathology in patients presenting to the emergency room. In-spite of this diagnostic difficulty, the use of CT imaging in the emergency department for acute delirium (in the absence of focal signs) has shown poor cost benefit (Hardy and Brennan 2008;Naughton et al 1997;Hufschmidt and Shabarin 2008).…”

Section: Discussionmentioning

confidence: 98%

Utility of Head CT Scan for Acute Inpatient Delirium

Vijayakrishnan¹,

Ramasubramanian²,

Dhand³

2015

Hospital Topics

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Delirium is a common occurrence in hospitalized patients, especially in the geriatric age group. Data was retrospectively reviewed for patients who developed delirium during hospitalization. Acute intracranial changes on imaging were noted only in four patients (11%) and all had preimaging clinical symptoms and signs, which warranted imaging. Imaging should be considered only in the presence of head injury, fall, history of anticoagulation, focal neurological signs, fever, and raised intracranial pressure. Development of more clear guidelines will result in decreased ordering of unnecessary neuroimaging, substantial cost savings, and less radiation exposure for patients.

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Section: Discussionmentioning

confidence: 98%

Utility of Head CT Scan for Acute Inpatient Delirium

Vijayakrishnan¹,

Ramasubramanian²,

Dhand³

2015

Hospital Topics

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“…Delirium with no focal neurological deficits is a common reason for requesting a CT brain scan, but it has a very low diagnostic yield [2,3,8,9]. The French guidelines regarding delirium in elderly patients recommend CT scan imaging only after a full clinical workup, which includes routine biology, electrocardiogram, chest radiograph, and urine dipstick [10].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical signs of intracranial pathology are sometimes obvious but more often are lacking in this population [1]. Moreover, altered sensorium and delirium may wrongly lead the physician to suspect a neurological cause when a drug or a non-neurological disorder is responsible [2,3].…”

Section: Introductionmentioning

confidence: 97%

Urgent computed tomography brain scan for elderly patients

Segard

Montassier

Trewick

et al. 2013

European Journal of Emergency Medicine

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We conducted a retrospective study of 291 patients aged 75 years or older who were admitted to the emergency department and who underwent a computed tomography (CT) brain scan. Our aims were to assess the reasons for requesting an urgent CT brain scan, to record the diagnostic yield of cerebral imaging, and to seek out predictive factors of an intracranial pathology. The three main reasons for requesting an urgent CT brain scan were the presence of localizing signs (60%), delirium (21%), and disorders of consciousness with a Glasgow Coma Score of less than 14 (14.5%). In our elderly population, we found no typical patient profile when concerned with the risk of having an intracranial pathology. The multivariate logistic regression found that predictive factors for intracranial bleeding were localizing signs, disorders of consciousness with a Glasgow Coma Score of less than 14, head trauma, sudden-onset headache, or headache associated with at least two episodes of vomiting.

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“…subdural haemorrhage, acute stroke, brain tumour) in 8-14% of patients diagnosed with delirium. 2 According to the British Geriatrics Society Guidelines, brain scanning is indicated in delirious patients with focal neurological deficits, in those who have had a fall, suffered a head injury and in those with signs of increased intracranial pressure. 3 Others also advocate scanning in patients taking anticoagulant treatment to identify intracranial haemorrhage.…”

Section: Symposium Report Introductionmentioning

confidence: 99%